My 84 year old mother lives with me in my condo. She has yet to be "officially" diagnosed but I'm told it is most likely dementia. She hears voices, singing and recently has been going outside to look for people. At night, she is somewhat combative and yells out the window to the voices that she hears. I am not sure we can afford assisted living, so I am considering a combo of home care and adult day care. What questions do you ask of a home care facility? Any thoughts and advice are appreciated!

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All good answers above!
My experience with in-home caregivers from agencies, has not been very good--not for Mom, and not for others I also care for.
Not that they are not nice--they are nice.
But often, those doing in-home care:
---Are trying desperately to sustain themselves; many are sick themselves with injuries or conditions which prevent them working regular jobs.
---Work for about HALF what agencies pay them.
---Agency management staff who assess/evaluate patients for home care, most often UNDER-evaluate. Partially to keep hours minimum, partly to help take load off facilities, I think.
It's common for them to miss existing conditions that might mean needed more hours of care, move to facility, etc., and which could lead to endangering the patient.
Part of this is families who desperately want to keep their elder at their own home, instead of moving them under their roof [many reasons], so they fail to tell those doing assessments of conditions that could change care or place of care.
Part of the misses is due to evaluators simply not being very observant, or not having enough time to do a proper assessment, or to the elder being a good "show-timer".

You can best help in-home evaluations/assessments, if you help the person doing assessments to see what they otherwise might miss; it's not about embarrassing you, it's about getting proper services for your elder.

IF you have a home care worker in your home, who you believe is impaired, or otherwise unable to do the work needed [like back pain impairing worker from doing a proper bathing of elder, for instance], Please DO call the agency to discuss it with them.
IF a worker comes to the house reeking of cigarette smoke, and it is a problem for your elder or yourself, tell them to leave, or wash first, then discuss it with the agency.
Agencies are NOTORIOUS, not only for under-assessing patients, but for sending workers to smoky houses they can't handle, or vice-versa, sending workers who smoke to homes that can't have chemicals in them.
Clients need to specify if there is smoking or common cleaning chemicals used in the house, so workers can be matched to clients they can work best with.
If a client is evaluated as being "partial care", or "light assist for transfers" that needs to be Accurate, or someone might get hurt.

One clue: smokers almost always believe their homes have no smell of it, believing sprays remove it or control it ok---they don't.
Those who routinely use chemically smelly products--cleaners, perfumes, laundry agents, etc., most often believe those are healthy and fine--they aren't.
---It's not about insulting anyone--it's about whether someone can still breath and speak coherently while in that house: some chemicals can impair neurological function that badly for some people, and can close down already fragile airways.

Another clue: often, family members want their elder to keep as much autonomy as possible, or prevent being pressured to take their elder under their roof---so they fudge how well their elder can function.
Conversely, families desperate for help might say their elder is more impaired than they really are--evaluators have a hard time figuring the straight facts on it.

Do what you can to make sure the initial assessment is as accurate as possible.
Inform the evaluator if you are Unable to handle your elder under your own roof--health problems, or other disabilities, etc. could be good reason to prefer placement in a facility.

Assisted Living may be too mild a level for an elder who is delusional or hallucinating. She may need a Doc to take a good look at her meds, to make sure nothing is causing mental issues--bad combos or wrong doses could cause that. So can poor nutrition. So can chemicals. Even exhaust from a vehicle outside, entering through the ventilation system, can cause odd behaviors and breathing issues.
A Doctor needs to officially evaluate your Mom, to determine what, if any, dementia is going on, or if it might be one of the above.
That would help determine placement or services.

If someone has dementias, an Adult Day Care that specializes in that, would be best. These folks should never be left alone at home. And, you would need plenty of break-time away from her, for your own sanity/well-being.

Please check with your nearest "Area Agency on Aging" to see what they might be able to suggest. It might be, there are places she can afford.

Please do not think you must go broke funding elder care for anyone but yourself. This is a mistake often made.
There are some State rules which might expect you to pay back for State services later, but even those States do not require family members to go broke and become State-Aid recipients too, just to pay back for the elder's care--they need to be let to know, what effect the State forcing you to repay your Mom's care would do to your situation--especially if repaying for Mom's care would cause you to need Welfare of any kind.

Please do not feel you HAVE to keep Mom under your roof.
IF that works for both of you--great! More often, it does not--particularly if the elder becomes combative, or continues to endanger themselves or others.

There are solutions; each solution must be tailored to individual circumstances.

It's very tough doing home care!
This site is great for helping with suggestions and morale support.
Please keep us posted how things are going!
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My mother in law is in assisted living and she has to be able to do everything on her own (accept meals and bath). I think that it sounds like your mom has already slipped past the requirements for AL. She might be able to qualify for Medicaid, though, for a nursing home. You certainly don't want her to wander off, if she were to go outside.
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I used to own an in-home care company. First, there should be a book called a Senior Resource Guide. You can find them in pharmacies, hospitals, nursing homes, independent living, any place seniors are served. This guide will give you some very good information. It is free.

I would start there. It ought to have a section devoted to in home care companies, and a graph showing what they do and how qualified they are. There are also good articles in the guide.

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One question you definitely want to ask of a home healthcare agency is whether they have staff available who are experienced in working with people with dementia. It takes a special set of skills to work with someone with dementia.
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